Prohormones in the Early Diagnosis of Cardiac Syncope
BackgroundThe early detection of cardiac syncope is challenging. We aimed to evaluate the diagnostic value of 4 novel prohormones, quantifying different neurohumoral pathways, possibly involved in the pathophysiological features of cardiac syncope: midregional–pro‐A‐type natriuretic peptide (MRproAN...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2017-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.006592 |
| _version_ | 1811275025039228928 |
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| author | Patrick Badertscher Thomas Nestelberger Jeanne du Fay de Lavallaz Martin Than Beata Morawiec Damian Kawecki Òscar Miró Beatriz López F. Javier Martin‐Sanchez José Bustamante Nicolas Geigy Michael Christ Salvatore Di Somma W. Frank Peacock Louise Cullen François Sarasin Dayana Flores Michael Tschuck Jasper Boeddinghaus Raphael Twerenbold Karin Wildi Zaid Sabti Christian Puelacher Maria Rubini Giménez Nikola Kozhuharov Samyut Shrestha Ivo Strebel Katharina Rentsch Dagmar I. Keller Imke Poepping Andreas Buser Wanda Kloos Jens Lohrmann Michael Kuehne Stefan Osswald Tobias Reichlin Christian Mueller |
| author_facet | Patrick Badertscher Thomas Nestelberger Jeanne du Fay de Lavallaz Martin Than Beata Morawiec Damian Kawecki Òscar Miró Beatriz López F. Javier Martin‐Sanchez José Bustamante Nicolas Geigy Michael Christ Salvatore Di Somma W. Frank Peacock Louise Cullen François Sarasin Dayana Flores Michael Tschuck Jasper Boeddinghaus Raphael Twerenbold Karin Wildi Zaid Sabti Christian Puelacher Maria Rubini Giménez Nikola Kozhuharov Samyut Shrestha Ivo Strebel Katharina Rentsch Dagmar I. Keller Imke Poepping Andreas Buser Wanda Kloos Jens Lohrmann Michael Kuehne Stefan Osswald Tobias Reichlin Christian Mueller |
| author_sort | Patrick Badertscher |
| collection | DOAJ |
| description | BackgroundThe early detection of cardiac syncope is challenging. We aimed to evaluate the diagnostic value of 4 novel prohormones, quantifying different neurohumoral pathways, possibly involved in the pathophysiological features of cardiac syncope: midregional–pro‐A‐type natriuretic peptide (MRproANP), C‐terminal proendothelin 1, copeptin, and midregional‐proadrenomedullin. Methods and ResultsWe prospectively enrolled unselected patients presenting with syncope to the emergency department (ED) in a diagnostic multicenter study. ED probability of cardiac syncope was quantified by the treating ED physician using a visual analogue scale. Prohormones were measured in a blinded manner. Two independent cardiologists adjudicated the final diagnosis on the basis of all clinical information, including 1‐year follow‐up. Among 689 patients, cardiac syncope was the adjudicated final diagnosis in 125 (18%). Plasma concentrations of MRproANP, C‐terminal proendothelin 1, copeptin, and midregional‐proadrenomedullin were all significantly higher in patients with cardiac syncope compared with patients with other causes (P<0.001). The diagnostic accuracies for cardiac syncope, as quantified by the area under the curve, were 0.80 (95% confidence interval [CI], 0.76–0.84), 0.69 (95% CI, 0.64–0.74), 0.58 (95% CI, 0.52–0.63), and 0.68 (95% CI, 0.63–0.73), respectively. In conjunction with the ED probability (0.86; 95% CI, 0.82–0.90), MRproANP, but not the other prohormone, improved the area under the curve to 0.90 (95% CI, 0.87–0.93), which was significantly higher than for the ED probability alone (P=0.003). An algorithm to rule out cardiac syncope combining an MRproANP level of <77 pmol/L and an ED probability of <20% had a sensitivity and a negative predictive value of 99%. ConclusionsThe use of MRproANP significantly improves the early detection of cardiac syncope among unselected patients presenting to the ED with syncope. Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01548352. |
| first_indexed | 2024-04-12T23:30:41Z |
| format | Article |
| id | doaj.art-ac4691f74ef8486489e525be2f4d17c0 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-12T23:30:41Z |
| publishDate | 2017-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-ac4691f74ef8486489e525be2f4d17c02022-12-22T03:12:18ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-12-0161210.1161/JAHA.117.006592Prohormones in the Early Diagnosis of Cardiac SyncopePatrick Badertscher0Thomas Nestelberger1Jeanne du Fay de Lavallaz2Martin Than3Beata Morawiec4Damian Kawecki5Òscar Miró6Beatriz López7F. Javier Martin‐Sanchez8José Bustamante9Nicolas Geigy10Michael Christ11Salvatore Di Somma12W. Frank Peacock13Louise Cullen14François Sarasin15Dayana Flores16Michael Tschuck17Jasper Boeddinghaus18Raphael Twerenbold19Karin Wildi20Zaid Sabti21Christian Puelacher22Maria Rubini Giménez23Nikola Kozhuharov24Samyut Shrestha25Ivo Strebel26Katharina Rentsch27Dagmar I. Keller28Imke Poepping29Andreas Buser30Wanda Kloos31Jens Lohrmann32Michael Kuehne33Stefan Osswald34Tobias Reichlin35Christian Mueller36Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandGREAT Network, Rome, ItalyGREAT Network, Rome, ItalyGREAT Network, Rome, ItalyGREAT Network, Rome, ItalyGREAT Network, Rome, ItalyGREAT Network, Rome, ItalyGREAT Network, Rome, ItalyDepartment of Emergency Medicine, Hospital of Liestal, SwitzerlandGREAT Network, Rome, ItalyGREAT Network, Rome, ItalyGREAT Network, Rome, ItalyGREAT Network, Rome, ItalyEmergency Department, Hôpitaux Universitaires de Genève, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandLaboratory Medicine, University Hospital Basel University of Basel, SwitzerlandEmergency Department, University Hospital Zurich, Zurich, SwitzerlandDepartment of Internal Medicine, Hospital of Lachen, SwitzerlandDepartment of Hematology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandCardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, SwitzerlandBackgroundThe early detection of cardiac syncope is challenging. We aimed to evaluate the diagnostic value of 4 novel prohormones, quantifying different neurohumoral pathways, possibly involved in the pathophysiological features of cardiac syncope: midregional–pro‐A‐type natriuretic peptide (MRproANP), C‐terminal proendothelin 1, copeptin, and midregional‐proadrenomedullin. Methods and ResultsWe prospectively enrolled unselected patients presenting with syncope to the emergency department (ED) in a diagnostic multicenter study. ED probability of cardiac syncope was quantified by the treating ED physician using a visual analogue scale. Prohormones were measured in a blinded manner. Two independent cardiologists adjudicated the final diagnosis on the basis of all clinical information, including 1‐year follow‐up. Among 689 patients, cardiac syncope was the adjudicated final diagnosis in 125 (18%). Plasma concentrations of MRproANP, C‐terminal proendothelin 1, copeptin, and midregional‐proadrenomedullin were all significantly higher in patients with cardiac syncope compared with patients with other causes (P<0.001). The diagnostic accuracies for cardiac syncope, as quantified by the area under the curve, were 0.80 (95% confidence interval [CI], 0.76–0.84), 0.69 (95% CI, 0.64–0.74), 0.58 (95% CI, 0.52–0.63), and 0.68 (95% CI, 0.63–0.73), respectively. In conjunction with the ED probability (0.86; 95% CI, 0.82–0.90), MRproANP, but not the other prohormone, improved the area under the curve to 0.90 (95% CI, 0.87–0.93), which was significantly higher than for the ED probability alone (P=0.003). An algorithm to rule out cardiac syncope combining an MRproANP level of <77 pmol/L and an ED probability of <20% had a sensitivity and a negative predictive value of 99%. ConclusionsThe use of MRproANP significantly improves the early detection of cardiac syncope among unselected patients presenting to the ED with syncope. Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01548352.https://www.ahajournals.org/doi/10.1161/JAHA.117.006592arrhythmiabiomarkerdiagnosissyncope (fainting) |
| spellingShingle | Patrick Badertscher Thomas Nestelberger Jeanne du Fay de Lavallaz Martin Than Beata Morawiec Damian Kawecki Òscar Miró Beatriz López F. Javier Martin‐Sanchez José Bustamante Nicolas Geigy Michael Christ Salvatore Di Somma W. Frank Peacock Louise Cullen François Sarasin Dayana Flores Michael Tschuck Jasper Boeddinghaus Raphael Twerenbold Karin Wildi Zaid Sabti Christian Puelacher Maria Rubini Giménez Nikola Kozhuharov Samyut Shrestha Ivo Strebel Katharina Rentsch Dagmar I. Keller Imke Poepping Andreas Buser Wanda Kloos Jens Lohrmann Michael Kuehne Stefan Osswald Tobias Reichlin Christian Mueller Prohormones in the Early Diagnosis of Cardiac Syncope Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease arrhythmia biomarker diagnosis syncope (fainting) |
| title | Prohormones in the Early Diagnosis of Cardiac Syncope |
| title_full | Prohormones in the Early Diagnosis of Cardiac Syncope |
| title_fullStr | Prohormones in the Early Diagnosis of Cardiac Syncope |
| title_full_unstemmed | Prohormones in the Early Diagnosis of Cardiac Syncope |
| title_short | Prohormones in the Early Diagnosis of Cardiac Syncope |
| title_sort | prohormones in the early diagnosis of cardiac syncope |
| topic | arrhythmia biomarker diagnosis syncope (fainting) |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.006592 |
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